Episode 66: Coding Crash Course with Riva Lee Asbell: The 25 modifier

Riva Lee Asbell rejoins the program to share her coding expertise regarding proper use of the 25 modifier in surgical retina. Riva now writes articles on her website (link). Be sure to check out her discussion of surgical retina coding (link) and in-office ophthalmic coding (link).

[1:25] Introduction

[2:40] You now are featuring your articles on your website. What was the first one about?

[2:55] Discussion of changes to vitrectomy coding.

[5:09] What do you need to peel to constitute a peel for retinal detachment coding?

[7:03] What is the history of the 25 Modifier? What was it designed to do?

[11:25] From a Medicare audit standpoint, why has this been so controversial in retina?

[13:02] Many make the mistake of assuming “if I examine the patient, I can bill for it.” However, some procedure codes include the pre-procedure exam bundled inside.

[15:45] On an initial visit, can a new patient be billed with the 25 Modifier?

[18:10] Is there a Medicare definition of how often you can perform and bill for a comprehensive exam?

[19:29] Hypothetical Example

[23:59] If a patient gets an injection and represents in 24hr (or less) with a complication, when can you unbundle this visit vs. use the 25 Modifier?